Self Assessment: Charge Entry and Protection
Use the following self-assessment tool to ensure that you have key processes covered ("yes" is the preferred response for each process). Then, check your performance measures against the better-practice target levels in the performance indicator section.
Charge Entry and Protection
1. The charge description master (CDM) coordinator reports to the chief revenue officer.
2. Have formal CDM change management process.
3. Formally review the CDM review process annually with all clinical departments.
4. "Static code" modifiers in the CDM and chose through the order-entry system.
5. Order all charge items through an on-line order-entry system.
6. Late and lost charge performance standards are in the department managers' job descriptions.
7. The annual HCPCS / CPT-4 changes are in place by January of each year.
8. Surgery HCPCS / CPT-4 codes appear in UB-92 form locator 44.
9. Surgery lab and X-ray charges are properly unbundled.
10. CDM pricing methodology is standardized and defensible.
11. Department staff understand the difference between "billable" and "payable."
12. CDM items have Patient Friendly Billing® descriptions.
13. Formally review the charge sheet and ticket review process annually.
14. Receive and review CPT-4 manual and Addendum B changes annually.
15. Build nursing procedures (such as CPR, infusion, etc.) into the CDM.
16. HIM staff assign interventional and surgical procedure codes.
17. Emergency room nursing levels of care are standardized and defensible.
18. Physicians' outpatient orders are received with requisite CPT-4 codes.
19. Order entry items map accurately to service codes.
20. Charge tickets and other documentation map accurately to service codes.
21. The charges in the CDM are appropriate for all services delivered.
22. Appropriately identify and capture APC pass-through items.
23. Charge data flow reliably from all points of service to the claim.
24. Convey modifiers correctly and reliably to the claim.
25. Correct Coding Initiative (CCI) edit conflicts are controlled by the correct regulation and charge entry.
26. Units of service are accurate and flow reliably to claims.
27. Monitor and enhance clinical departments' "charge awareness."
Key Performance Indicators
1. Late charge hold period ("suspense days")
2 - 4 days
2. Late charges as a percentage of total charges
3. Lost charges as a percentage of total charges
4. CDM duplicate items
5. CDM incorrect or missing HCPCS or CPT-4 codes
6. CDM incorrect or invalid revenue codes
7. CDM revenue codes lacking necessary HCPCS or CPT-4 code
8. CDM item has invalid or incorrect modifier
9. CDM item has missing modifier, if applicable
10. CDM item price is less than hospital outpatient PPS APC rate
11. CDM item price is $0
12. CDM item description is "miscellaneous"
13. CDM item description or price is editable on-line.
This checklist was based on HFMA's February 2004 audio webcast, "Developing Key Performance Indicators for the Revenue Cycle," by David Hammer, Vice President, Revenue Cycle Management Services, McKesson Information Solutions, and Roland Funsten, Assistant Vice President, Revenue Cycle Operations, St. Vincent Hospital, Indianapolis, IN. Questions or comments may be directed to email@example.com or firstname.lastname@example.org
Publication Date: Tuesday, August 03, 2004